Packages Episodes Bundles OH MY! Deb Lauricia, Senior Director Strategic Initiatives, Revenue Cycle February 16, 2017

Agenda Who we are History of bundling at Cleveland Clinic Current initiatives International arena Challenges Where we are headed

Since 1921 A Unique Model of Care Four doctors share a vision Non-profit, physician-led group practice Collaboration across disciplines All physicians are salaried Patient-centered mission FRANK E. BUNTS, MD JOHN PHILLIPS, MD GEORGE CRILE SR., MD WILLIAM E. LOWER, MD

Cleveland Clinic Today 49,000 caregivers 6.6 million total visits 164,000 hospital admissions 3,400 physicians & scientists 1,888 residents & fellows Fast Facts Figures as of 7/2012

2016 Cleveland Clinic U.S.News & World Report #1 in Cardiology & Heart Surgery; 22nd consecutive year 9 specialties ranked in top 3 Ranked in 14 specialties Cleveland Clinic Children’s ranked in 9 pediatric specialties

Bundling Specialty Medical Care Program Began 20 years ago as means to drive volume and provide predictable pricing Includes both the professional and technical services for a single encounter High end inpatient Small provider networks and large payers

Bundling Program for Advanced Medical Care Expanded to include additional procedures and chronic conditions Broad based commercial contract offering Local Employers Limited outpatient

Episodes Transplants Includes pro and tech Multiple payment methodologies Phases Flat rates Fee for service up to maximum reimbursement

Episodes Time Based Fixed period of time All related services Pro, tech, ancillary, etc Single rate, single authorization Direct to Employer business

Episodes Clinical Based Defined clinical pathway Retrospective Medicare BPCI Cardiac Rehab Comprehensive Joint Replacement CJR Ohio Medicaid State Innovation Models

Population Health Patient Centered Medical Home (PCMH) Medicare Accountable Care Organization (ACO) Comprehensive Primary Care Plus (CPC+) Package additional services into standard care IE: Chonic care management, outreach, etc.

International DRG based bundles Other services percent of charge Self pay, Embassy, International Payers Moving to clinical based

Challenges Patient Identification Registration issues Manual claims process Partnering with vendor for automation Payment reconciliation Small volumes 292 cases / $21.5M

Future State Clinical Guarantees CPC+ Management Expansion of clinical bundles to commercial business Prospective Specialty Bundles: TAVR Employee Health Plan Pilots Gain Sharing

Take Aways Find what you do well and start there Map your clinical process Prepare for data, a lot Insource vs Outsource Patient identification is critical Build a strong front end, lock it down Resource for a manual billing flow Technology is advancing Create a process to handle the outliers Reconcile, reconcile, reconcile